Sepsis Case Study

Sepsis Case Study
According to the National Institute of General Medical Sciences severe sepsis strikes about 750,000
people in the United States each year and kills an estimated 28 to 50 percent of those individuals.
The most vulnerable populations for sepsis are the elderly and newborns. After completing the
whole eleven segments, I learned that anyone with an infection may be at risk for developing sepsis.
The whole scenario helped me how to screen for sepsis and how important is to recognize and
respond appropriately to early signs of sepsis in hospitalized patients. Once sepsis is diagnosed,
early and aggressive treatment can begin which greatly reduces mortality rates associated with
sepsis. After completing the whole scenario I learned how to approach
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Research Paper On Psoriasis
PSORIASIS AS A SYSTEMIC INFLAMMATORY DISEASE:
There is increasing awareness that psoriasis as a disease is more than "skin deep" and that it has
important systemic manifestations that are shared with other chronic inflammatory diseases, such as
Crohn's disease and diabetes mellitus. The shared conditions include the metabolic syndrome,
depression, and cancer.3 It is unclear whether cancer, particularly lymphoma and skin cancer, is
related to the disease or its treatment (Gelfand et al., 2006).
An associated arthropathy, psoriatic arthritis, has features in common with psoriasis but is
considered to be a distinct disease entity with a distinct therapeutic spectrum (Ravindran et al.,
2008). Of emerging significance is the relationship ... Show more content on Helpwriting.net ...
Also it serves as a model for studies of mechanisms of chronic inflammation. In addition it is
increasingly a first–choice disease indication for studies of new pathogenesis based therapeutic
strategies. The relevance of cutaneous versus systemic factors, and the role of genetic versus
environmental influences on disease initiation, progression, and response to therapy (Saurat et al.,
2008).
Alefacept and Efalizumab, the first T–cell targeted biologic agents, have confirmed the concept of a
role of T cells in established inflammatory disease. However, there are multiple problems, including
long–term efficacy, relapse after drug withdrawal, safety, and costs, are driving the search for new
and better therapies(Leonardi et al., 2008).
However, the long–term safety of biologic agents is an unresolved issue and will be addressed in a
satisfactory manner only if there is optimal use of and investment in post marketing surveillance of
these drugs, including the development of comprehensive registries of biologic drugs (Gladman et
al.,

Sepsis Case Studies
Sepsis continues to be a significant cause of death and morbidity in the intensive care unit (ICU),
with documented mortality rates as high as 50% (Nargis, Ibrahim, & Ahamed, 2014). It is also
estimated to be the principal cause of death and illness worldwide (Singer et al., 2016). Moreover,
the socioeconomic costs related to sepsis were determined to be more than $20 billion in 2011 in the
United States (Balk et al., 2017). Also, there has been a steady increase in the incidences of sepsis as
the technological advances in medicine allow for more invasive procedures, the growth of multi–
drug resistant organisms, and an aging demographic (Nargis, Ibrahim, & Ahamed, 2014). Therefore,
timely diagnosis and treatment of sepsis are paramount. ... Show more content on Helpwriting.net ...
Table 1.1 SIRS (Systemic Inflammatory Response Syndrome)
Two or more of:
 A rectal temperature > 38.5°C or 36°C;
 Heart rate more than two standard deviations (SD) above the normal, or bradycardia in children
older than one year (< 10th percentile for age);
 Respiratory rate more than two SD above normal (or pCO2 < 32 mmHg);
 Leukocyte count > 12,000 cells/mm3, (–– removed HTML ––) 10% band forms. From Sawaya,
Chedid, & Majzoub, 2017
Sepsis will be defined as SIRS with positive microbiological cultures whether respiratory, blood, or
urine. Participants in the suspected sepsis group are those who meet SIRS criteria but have negative
microbiological findings but have positive screening results such as elevated lactate, glycemic
instability, thrombocytopenia, or abnormal radiological findings such as consolidation on chest x–
ray, patchy infiltrates, etc. Finally, septic shock will be defined as sepsis with hemodynamic
instability as evidenced by persistent hypotension despite fluid resuscitation measures and the need
for inotropic or vasoactive infusions (Asadi,

Sepsis Case Studies
Introduction
Sepsis is a systemic response to infection that leads to severe sepsis and septic shock (Dellinger et
al., 2013). Severe sepsis and septic shock are major health concerns, affecting millions of people,
and killing one in four (Dellinger et al., 2013). Multisystem organ failure (MOF) is one of the
leading causes of death of hospitalized patients with the underlying condition of sepsis (Rittirsch,
Redl, & Huber–Lang, 2012).
TP is a 57 year old male who presented with severe abdominal pain. His past medical history
includes meningitis, hydrocephalus with VP shunt placement, gastroesophageal reflux disorder,
seizure disorder, generalized weakness, and hypertension. TP also has a psychiatric history of
bipolar and schizophrenia. TP's ... Show more content on Helpwriting.net ...
Health outcome has five elements, which include utilization of healthcare services, clinical health
status indicator, severity of healthcare problem, adherence to the recommended care regimen, and
satisfaction with care (Mathews, Secrest, & Muirhead, 2008). Healthcare utilization refers to using
the resources within the facility to provide appropriate care for TP. Clinical status indicators are TP's
results of laboratory studies, diagnostic tests, and physical exam findings that indicate his clinical
status as worsening or improving. Problem severity includes the consequences of no treatment and
treatment. This means the provider and TP must discuss what would happen if treatment did not take
place and discussing which treatment is best for TP with the least amount of complications or side
effects. Adherence refers to continuing to include TP in the treatment plan and educating him along
the way to prevent his resistance. Satisfaction with care will help determine long term adherence to
the plan of care for TP. If he feels satisfied with his treatment plan, he may change his behavior and
adhere to recommendations after

Pathophysiology Of Postoprative Hypovolaemia And The Body...
1. Pathophysiology of Postoprative Hypovolaemia and the body's compensation mechanisms:
Presented with the post–operative assessments of Mr. George Jensen who suffered from an open
fracture of his right tibia and fibula and underwent an Open Reduction and External Fixation
procedure, a nurse can tell that he is experiencing post–operative Hypovolaemia.
Hypovolaemia pertains to an abnormal loss of blood volume and body fluid. It is a life–threatening
condition brought on by low blood venous return to the heart that results to decreased Cardiac
Output (CO), leading to a lack of adequate circulatory filling, reduced organ blood flow and organ
damage (Brown & Edwards, 2013; Craft, Gordon, Huether, Tiziani, McCance, & Brashers, 2013;
Plenderleith, 2007).
There are numerous factors responsible for the onset of hypovolaemia. But among the most
common causes and relevant to Mr. Jensen are:
o Haemorrhage from trauma, or surgery. It is the common cause of body fluid loss, and it may be
internal or external. In the limbs, a considerable amount of blood can be lost to a fractured tibia
(Page & McKinney, 2012, p.157).
A patient who undergoes surgery such as an open reduction external fixation fracture under general
anaesthesia can futher have an estimated blood loss in volume of 200cc, as suggested by Mendelson,
Kates, Pacos, Clark, & Wu (2011, p. 3).
o Dehydration that can be a result not just of poor fluid intake but also of badly managed Type 2
Diabetes Mellitus. Blood

The Importance Of Sepsis
Sepsis continues to be a major cause of death and morbidity in the intensive care unit (ICU), with
documented mortality rates as high as 50% (Nargis, Ibrahim, & Ahamed, 2014). It is also estimated
to be the principal cause of death and illness worldwide (Singer et al., 2016). Moreover, the
socioeconomic costs related to sepsis were determined to be more than $20 billion in 2011 in the
United States (Balk et al., 2017). Also, there has been a steady increase in the incidences of sepsis as
the technological advances in medicine allow for more invasive procedures, the growth of multi–
drug resistant organisms, and an aging demographic (Nargis, Ibrahim, & Ahamed, 2014). Therefore,
timely diagnosis and treatment of sepsis is paramount. Even a one–hour delay in treatment has been
associated with increased mortality rates of 5%–10% (Mehanic & Baljic, 2013; Sawaya, Chedid, &
Majzoub, 2017). Isolation of microbiological cultures have traditionally been held as a definitive
diagnosis of sepsis. However, result times for these cultures are typically 48–72h and may ... Show
more content on Helpwriting.net ...
PCT kit. This automated test has been proven to be accurate in analyzing human serum or plasma
with an enzyme–linked fluorescent assay technique and has been used in almost all of the studies
reviewed in the literature (Leli et al., 2014; Li et al., 2014; Lin et al., 2017; Nargis, Ibrahim, &
Ahamed, 2014; Oliveira et al., 2013). CRP levels will be measured using VITROS (Johnson &
Johnson Clinical Diagnostics, Inc., Rochester, NY). Blood cultures will be analyzed using the BD
BACTEC system. This blood culture media has also been used consistently in many of the studies
used in the review of the literature (Lin et al., 2017). A PCT assay of > 0.5 ng/ml will be deemed
pathological. CRP levels will be less specific and be based rather upon trends because the
inflammatory response to surgery alone may elevate CRP without any indication of

Septic Inflammatory Response Syndrome (SIRS)
The word "sepsis" is derived from the ancient Greek word for rotten flesh and putrefaction. Since
then, a wide variety of definitions have been applied to sepsis, including sepsis syndrome, severe
sepsis, bacteremia, septicemia and septic shock In 1991, the American College of Chest Physicians
(ACCP) and the Society of Critical Care Medicine (SCCM) developed a new set of terms and
definitions to define sepsis in a more "precise manner" [1, 2]. These definitions take into account the
findings that sepsis may result from a multitude of infectious agents and microbial mediators and
may not be associated with detectable bloodstream infection. The term "systemic inflammatory
response syndrome" (SIRS) was coined to describe the com– mon systemic response to a wide
variety of insults. When SIRS was the result of a suspected or confirmed infectious process, it is
termed "sepsis". ... Show more content on Helpwriting.net ...
Septic shock is a subset of severe sepsis and was defined as "sepsis–induced hypotension persisting
despite adequate fluid resusci– tation" (see Fig. 12.1). While the quantity of fluid that qualifies as
"adequate fluid resuscitation" is controversial, we believe septic shock is best defined as a "mean
arterial pressure (MAP) less than 65 mmHg after a fluid challenge of 20 mL/Kg body weight (given
30–60 minutes) in patients with sepsis and in the absence of other causes for hypotension" (also see
Chap. 14). According to the ACCP/SCCM defini– tions, three stages in the hierarchy of the host's
response to infection were recognized, namely, sepsis, severe sepsis and septic shock, with sepsis
having the best prognosis and septic shock the worst. While the use of the SIRS criteria to define
sepsis is some– what controversial [3–6], many consider sepsis to be best defined as the "systemic
response to infection with the presence of some degree of organ dysfunction"

The Cause Of Maternal Death Worldwide
Abstract Maternal sepsis is preventable, yet remains the leading cause of maternal death worldwide,
according to a study published in 2013 (Acosta & Knight, 2013). Early recognition of symptoms
and implementation of correct treatment is key to prevent mortality. A break in nursing education
can prevent prompt treatment to patients. Given that pregnant women are more vulnerable to
infection and susceptible to serious complications, makes a clear understanding of maternal sepsis
imperative (Joseph, Sinha, Paech, & Walters, 2009). The purpose of this project was to determine if
there is a need on Memorial Hospital's LDRP unit for more education related to maternal sepsis.
Memorial Hospital, located in York, Pennsylvania is a small ... Show more content on
Helpwriting.net ...
Even though sepsis is a major contributor to maternal mortality, septic shock in pregnancy
fortunately is relatively rare, affecting only 0.002% to 0.010% of all births (Dutra & Olvera, 2016).
Regardless of how low the statistics, maternal mortality happens and the preparedness of units will
influence a positive outcome. A needs assessment identifies the discrepancy between the present
knowledge and the desired knowledge to develop protocols and education which will bridge the gap
between the "what is" and "what should be". The needs assessment developed for the 23 staff
members on the small LDRP unit of Memorial Hospital focused on what the end knowledge base
should be. Questions were formulated after an extensive literature review, focusing on early
recognition, definitions and specifics for care. This needs assessment will help implement protocols
that will improve the care provided, as well as the comfort of the staff members face to face with
perinatal mothers.
Review of Literature Critical management of maternal sepsis is key in preventing mortality and
identifying a patient at risk can help with initiation of management. There are many risk factors of
sepsis during pregnancy. Hashmi and Khan (2014) identified that pregnant women are highly
susceptible to infection due to the maternal immune response being decreased. Some of the risk
factors named included cesarean

The Overwhelming Infection of Septic Shock
Kleinpell states, "Septic shock is the result of an overwhelming infection, leading to hypotension,
altered coagulation, inflammation, impaired circulation at a cellular level, anaerobic metabolism,
changes in mental status and multiple organ failure (as sited in Garretson & Malberti, Ignatavicius
and Workman (2009), "sepsis is a widespread infection coupled with a more general criteria: body
temperature higher than 380C or lower than 360C, heart rate greater than 90 beats per minute,
respiratory rate greater than 20 breaths per minutes, and WBC count greater than 12,000/mm or
lower than 4,000/mm or with more than 10% bands (Spaniol, Knight, Zebley, Anderson, Pierce,
2007). Endotoxins from gram–negative bacteria, such as Escherichia coli, can precipitate the
common progression of events leading to septic shock. A patient experiencing SIRS is at risk for
organ failure (severe sepsis), multiple organ dysfunction syndrome, and death. This paper will
outline the details surrounding this condition, from a nursing standpoint. Early sepsis is defined as
"a suspected or proven infection and the systemic response to infection" (Porth & Matfin, 2009).
During early sepsis, a hypodynamic state of vasodilation, increased release of pro–inflammatory
cytokines, pooling of blood, cellular hypoxia, and vascular damage cause microthrombi. This
sequence of events can lead to Systemic Inflammatory Response Syndrome (SIRS) and potential
death if undetected and untreated. Detection and

The Potential Life Threatening Effects On Septic Shock
INTRODUCTION This clinical report will be discussing the potential life threatening effects "from
cellulitis to septic shock". Cellulitis is the starting cause of an infection that will lead through the
sepsis cycle, finishing with the severe part septic shock (Swartz, 2004). Analysation of the
interrelationships between localised infection, systemic inflammation response syndrome (SIRS),
and the sepsis course will be discussed throughout this report. Additionally, this report will
incorporate comprehensive detail of the physiological systemic weakening that can prompt septic
shock. Finally, in–depth details about the investigation towards the red flags of disintegration, for
example, intense respiratory trouble disorder will be analysed.
METHODS Various methods were used during the direction of this clinical report. Different sources
were investigated using the AUT library and online database to assemble books and journal articles.
To guarantee that the data assembled was of high scholastic quality, genuine distributed books and
companion, peer reviewed articles were utilised. At the point when inquiring about utilizing
electronic databases. The resources found to conduct this report were published in English from the
year 1998 to 2016. Keywords used to distinguish relating diary articles were sepsis, localised
infection, septic shock, multiple organ dysfunction syndrome (MODS), and systemic inflammatory
response syndrome (SIRS). Newspapers to magazines and daily paper

Sepsis Case Study In Nursing
The evolution of this project cultivated from the need of improvement for patients suffering from
sepsis at MacNeal Hospital. Sepsis is a potentially fatal host response to infection that occurs as a
systemic inflammatory response syndrome (Schub & Schub, 2013). I felt it was very important to
re–evaluate what I can do as a nurse to improve the expected outcomes of sepsis patients and
decrease their length of hospitalization. If a patient is admitted with severe sepsis, it places the
patient at a higher level of risk than if he/she was admitted with an acute myocardial infarction or
acute stroke (Robson & Daniels, 2013). I became interested in sepsis as my project when I became
informed that MacNeal had started a Patients With Sepsis Orders Daily Reports, I decided I could
enhance and develop an educational tool to help the case managers, emergency room nurses, and
staff nurses with early recognition of sepsis and decreasing the length of stay. Angus and Van der
Poll (2013) stated that the United States reported 2% of patients that were admitted to the hospital
suffered from severe sepsis.
In ... Show more content on Helpwriting.net ...
While I have achieved a comfort level with using the computer to research, at times it can become
very frustrating for me to develop the confidence I need to self–assurance with research. To help
develop my reassurance, I reached out for the assistance of my local librarian, the librarian at Lewis
University, and my preceptor. I would gather the information, print it, and refer to the assistance of
my preceptor on our scheduled meeting days to receive help with my information that I gained.
Also, I found creating a PowerPoint was difficult. I believe it has a lot to do with the design options
that available. My friends, colleagues, and watching YouTube videos helped me so that I can
become confident with completing my

Sepsis in the Emergency Department: Improvements in Rapid...
Abstract
Sepsis remains one of the most deadly diseases in the country. According to the literature, a majority
of sepsis cases filter though the Emergency department. The diagnosis and treatment of sepsis are
complex and the barriers to improving these things are even more intricate but the fact remains that
improvement of sepsis care begins in the ED. Early recognition of sepsis using the SIRS criteria
followed by multidisciplinary rapid response diagnostic testing and treatment are the keys to
improvement of sepsis care in the ED.
Introduction
Sepsis is defined by the Surviving Sepsis Campaign (SSC) as "the presence (probable or
documented) of infection together with systemic manifestations of infection" (Dellinger et al., ...
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Ileus
8. Hyperbilirubinemia (plasma total bilirubin level > 4 mg/dL)
9. Hyperlactatemia (> upper limit of normal)
(Simpson & Pitts, 2010)
Management of Severe Sepsis:
More than 500,000 cases of severe sepsis are initially managed in the US emergency departments
annually, with an average ED length of stay of 5 hours. The cornerstones of management of severe
sepsis includes prompt diagnosis, timely administration of appropriate antibiotics, and aggressive
resuscitation.
Recognition of Sepsis in the ED. It is well known within health care professionals as well as the
general public that, in the first hours of a myocardial infarction or cerebral vascular accident, time is
tissue. This is also the case in severe sepsis and because of this, early recognition of sepsis is vital to
improving outcomes. SIRS is the first line diagnostic for the recognition of sepsis. If the patient
meets SIRS criteria, the next line of diagnostics is to test the serum lactate. Lactate is believed to be
due to decreased end–organ perfusion, leading to anaerobic glycolysis and lactate production. Serum
lactate is commonly used as a prognostic test for illness severity in ED patients with sepsis (Green et
al., 2011).
Resuscitation in the ED. Rapid Quantitative resuscitation is recommended in all patients with tissue
hypoperfusion. According to the SSC guidelines, the goals of fluid resuscitation include a CVP of 8–
12 mm Hg, a MAP > 65 mm Hg, urine

Circulatory Shock
Circulatory shock is a syndrome of widespread cellular hypoxia, triggered by a systemic alteration
of perfusion and delivery and/or utilization of tissue oxygen, eventually causing end–organ
dysfunction and death [53]. It can be subdivided into 4 distinct categories according to its primary
pathophysiological mechanism, namely cardiogenic, hypovolemic, obstructive and distributive [54].
In the first 3 types, perfusion has changed as a consequence of the cardiac output decrease, whereas
distributive types of shock are related to a primary dysfunction of the resistive component of the
cardiovascular system. In vasoplegia, vascular tone is reduced and there is a noticeably depressed
constrictive response of arterioles to vasoconstrictors, and ... Show more content on Helpwriting.net
...
Various contributing mechanisms have been identified, including the negative inotropic effects of
different circulating factors, especially cytokines (TNFα, IL–1β and IL–6), lysozyme c and
endothelin–1, disturbances of intracellular calcium trafficking within cardiac myocytes, alterations
of myocardial microvascular blood flow, mitochondrial abnormalities and autonomic dysfunction
[71–73]. There are various effects which may be responsible for the toxic actions of peroxynitrite on
the heart, including myocardial cell death, either by caspase–3–dependent apoptosis [74], or PARP
mediated necrosis [75]. A direct correlation linking the degree of myocardial PARP activation and
the severity of cardiac functional alterations has been established in humans with septic shock [76].
Myocardial contractility can also be impaired by peroxynitrite due to disturbance in regulatory
mechanism of intracellular calcium through the inactivation of SERCA2A [77], by altering different
myofibrillar proteins including actin, myosin [78] and alpha–actinin [79], by interrupting
myofibrillar energetics through inactivation of the myofibrillar isoform of creatine kinase [80] and
by activating matrix metalloproteinases [81], which promotes contractile failure by cleaving key
sarcomeric proteins including troponin and myosin light chain

Causes And Treatment Of Sepsis
'Sepsis', a lame man might hear of this word and have no clue or whatsoever of what this is – but in
the real world it's not something to be happy about and has been a major issue in the medical field.
Sepsis is a complex condition which doesn't have a specific definition, diagnosis or treatment but
one thing the medical practitioners are specific of is the origin. Sepsis is from a Greek word called
"Sepo" which means "decay" idiomatically known as "Blood poisoning" (Steen C., 2009). The
medical field defines it as "Systemic Inflammatory Response Syndrome (SIRS) resulting from the
presence of pathogens or their toxins as in septicaemia that occurs during an infected state." (Sepsis
Alliance, 2014). It is caused by a systematized ... Show more content on Helpwriting.net ...
The organisms involved are staphylococcus and pseudomonas sp. About 60% of patients are as a
result of cell membrane of gram–negative bacteria and 40% of gram–positive bacteria attach to
binding protein on exterior immune cells identified by "CD14" receptors (Dob et al. 2007). Perrin
(2009) suggested that that the body react to sepsis in three different phases; "inflammation,
thrombosis/coagulation and Fibrinolysis". The inflammatory phase of sepsis white blood cells
discharges "proinflammatory cytokines", neutrophils and bacteria stimulates the "proinflammatory
cytokines" in severe sepsis however damaging the endothelium stimulating the coagulation cascade.
Thrombosis is produced as the coagulation cascade is being stimulated giving rise to "procoagulant
state" and "endothelial damage". The final phase; fibrinolysis is slowed resulting to an interruption
between clot development and disintegration balance, the imbalance leads to systemic inflammation.
Inflammatory Cascade is the throbbing, reddishness, swelling and loss of function in the body which
is constantly under attack from aggressive organism but nevertheless has the power to fight such
attacks (Steen C., 2009). This is a normal phenomenon because it helps protect the body from injury
and endurance from infection and as time goes on the aggressive organism is weakened which
makes the body stable and healthy. There are three stages

Symptoms And Diagnosis Of Sepsis
With sepsis becoming a growing concern with each passing day, we must develop new ways to
combat it aggressively. With EMS becoming a more advanced, educated, and integral member of the
health care team; there must be an inclusion of them into the early and advanced treatment of sepsis.
According to a research team in the Netherlands 3.3 out of every 100 patients encountered by EMS
in the United States have severe sepsis diagnoses, compared to only 2.3 per 100 for myocardial
infarction and 2.2 per 100 for stroke (Van der Wekken et al., 2016). This is massive considering it is
not considered a time critical diagnosis like myocardial infarction and stroke already are. The
Revised Sepsis Syndrome Classification and Prehospital Sepsis Alert Score are the potential solution
to these issues and look to increase rapid recognition, advanced treatment, and decrease mortality
from this destructive and aggressive pathological process.
Research Proposal: Prehospital Sepsis Score and Alert Protocol For Early Detection and Treatment
of Sepsis and Septic Shock
INTRODUCTION
Sepsis has become the newest major threat to health in not only the United States, but worldwide.
With the progression of bacterial infections becoming more resistant to antibiotics because of
inappropriate and incomplete treatment, stronger, more resistant, and more dangerous "superbugs"
have begun to emerge. An aging population with a multitude of comorbidities, and the rise in
immunosuppressed populations

Sepsis Case Studies
On his death certificate they declared his cause to be Sepsis by an unknown origin. Sepsis is defined
as a systemic inflammatory response that occurs within the body due infection within the
bloodstream. Common sites for infection that cause sepsis include pneumonia, kidney infections, or
abdominal infections. The infection can be either bacterial, viral, or fungal. The most common gram
positive organisms include staphylococcus aureus and enterococci. Common gram negative
organisms include pseudomonas species and E. coli.
When an inflammatory response happens white blood cells release endotoxins and exotoxins that
destroy the bacteria causing infection. However, these toxins also cause damage to the surrounding
blood vessels and therefore leak into the ... Show more content on Helpwriting.net ...
If SIRS continues it can eventually lead to organ failure, due to decreased cardiac output and an
increased peripheral vascular resistance. If severe hypotension occurs, the individual can go into
septic shock. Fluid replacement therapy usually will not recover the patient at this point.
When a patient has sepsis early symptoms will include those that define SIRS; abnormal body
temperature, increased heart rate, increased respiratory rate, and/or abnormal white blood cell count.
If these symptoms are left untreated, organ failure will start to occur. Signs of organ failure can
include decreased urine output, sudden changes in mental status, difficulty breathing, decrease in
platelets and abnormal heart rhythms. Decreased cardiac output and hypotension may also start to
occur, which indicates septic

Post-Cardiac Arrest Syndrome Case Study
All patients' post–cardiac arrest has risks associated ICU level of care such as acute respiratory
distress syndrome (ARDS), pneumonia, debilitation, PE, depression, and so on. Post–cardiac arrest
syndrome (PCAS) is a unique condition that is associated with CA. It is an umbellar term for the
major complications for complications that are directly associated with CA, which include brain
injury, cardiac dysfunction, and systemic inflammatory response (SIRS). Ischemia related injuries
are the pathogenesis of all the complication. And, the physiological response these complications
can overlap. For instance, tachycardia can be caused by cardiac dysfunction and SIRS. Brain
injuries are one of the major complications. It is the main cause of disability

Sepsis Case Studies
Early identification of sepsis is crucial when caring for patients at risk for sepsis. The
earlier sepsis is identified the sooner health care professionals can implement treatment, which
can prevent the disease from advancing into septic shock. "Sepsis can lead to shock, multiple
organ failure, and death, especially if it is not recognized and treated promptly. Sepsis remains
the primary cause of death from infection despite medical advances that include vaccines,
antibiotics, and acute care; millions of people around the world die of sepsis each year. Often,
sepsis is not recognized as a medical emergency until a patient's condition starts to decline."
(Buck, 2014) "Sepsis is defined as the ... Show more content on Helpwriting.net ...
(Buck, 2014) Once a patient
has triggered a sepsis alert, another alert will not be triggered for 24 hours. (Buck, 2014) The
results of the new Sepsis Alert Program showed, "Only 17% (n = 102) of the 617 patients who
triggered a sepsis alert during the first 8 months of the program had a discharge diagnosis of
sepsis, severe sepsis, or septic shock. It was discovered that 40% of the 995 sepsis alerts (n =
394) had required an intervention of some kind. These interventions included evaluation by a
physician, intravenous fluids, laboratory work, medication administration, respiratory support,
and/or transfer to a higher level of care." (Buck, 2014) The results showed that the Sepsis Alert
Program identified patients in decline, and although the final diagnosis of sepsis was only 17%,
the alert has been a positive effect on patient care. (Buck, 2014) The study stated that the Sepsis

Alert Program is still being used and the facility is still trying to improve the sensitivity of the
alert to be for Sepsis diagnosis. (Buck, 2014) The improvement on rapid identification of patients
who needed additional interventions because their declining health status is an

Nursing Case Studies Septic Shock
Analysis of Disease: Septic Shock
Septic shock, a potentially lethal drop in blood pressure due to infection, is not completely
understood even with the progress made in science and medicine throughout the years (Heuther &
McCance, 2012). It is one of the most common causes of death in the intensive care unit (ICUs) in
the United States of America each year, with a mortality rate of 28 to 60 percent (Heuther &
McCance, 2012, p. 632). Septic shock is most commonly caused by bacteria, often gram–positive
bacteria, acquired while in the hospital, and those who have conditions that reduce their ability to
fight infection are most at risk (Young, 2008). This at risk population includes newborns, those over
35 years old, those with diabetes or cirrhosis, ... Show more content on Helpwriting.net ...
The treatment of septic shock requires hospital admission as soon as the diagnosis is suspected,
although most cases do occur while an individual is already hospitalized (Kalil, 2014, Treatment
section, para. 1; Young, 2008, Causes section, para. 1). Treatment includes the use of antibiotics,
support of respiratory and circulatory function, supplemental oxygen, mechanical ventilation, and
intravenous fluid in large amounts (Kalil, 2014, Treatment section). Hemodynamic monitoring,
which is the monitoring of pressure in the heart and lungs, may also be used in the treatment of
septic shock (Hadjiliadis et al., 2014). "Drugs, such as dopamine or norepinephrine (which cause
blood vessels to narrow), may be needed to increase blood flow to the brain, heart, and other organs"
(Young, 2008, Treatment section, para. 4). In cases where the infection is localized or the etiology is
completely unknown, surgery may be necessary to help to correct and treat the septic shock (Kalil,
2014, Treatment

Sepsis In Critically Patient
Sepsis in the Older Patient
Sepsis is a common condition in critically ill patients. Cases of sepsis rose by an average of 9% per
year (Nasa P, 2012) and the number elderly patients being admitted to ICU's has increased recently.
One of the reasons for this trend is that people are living longer. The world's population of people
over the age of sixty has been increasing steadily. It has been projected that over the next twenty
years the number of people over the age of eighty will be double and that by the year 2050 the
population of elderly people will be greater than that of young people for the first time in history
(World Population Ageing 1950–2050, 2001). In the elderly person, sepsis is a major cause
hospitalization and ultimately death. The risk factors, susceptibility, and management are
determinates in the outcome for the elderly patient. ... Show more content on Helpwriting.net ...
Sepsis, severe sepsis, and septic shock are especially critical in the elderly patient. Even with all of
the developments in treatment and management of patients with sepsis, it is still the second leading
cause of death in patients in regular ICU's (not including coronary ICU's). The occurrence of sepsis
and severe sepsis increases with age. In the hospital, the elderly make up two thirds of patients
admitted with sepsis. The rates of deaths from severe sepsis are directly associated with older age,
the highest number of deaths was in the patient over eighty years of

Essay On Multiple Organ Dysfunction Syndrome
Introduction
The aim of this assignment is to reflect on the management of a patient with multiple organ
dysfunction syndrome (MODS). Reflective practice is associated with learning from experience,
(Johns & Freshwater 1998) and viewed as an important strategy for health professionals who
embrace life long learning (Department of Health 2000). Engaging in reflective practice is
associated with the improvement of the quality of care, stimulating personal and professional growth
and closing the gap between theory and practice (Benner 1984; Johns & Freshwater 1998).
Central to Johns' idea of reflective practice is the goal of accessing, understanding and learning
through direct experience. It is this that enables the practitioner to ... Show more content on
Helpwriting.net ...
Potassium levels were also increasing (6.8) and his urea and creatinine were markedly deranged. He
also began to appear grossly oedematous.
Mr Cox's sedation was stopped (Midazolam and Morphine) following the insertion of a
tracheostomy. However, due to encephalopathy he never regained consciousness. Despite many
attempts he was difficult to wean from the ventilator and eventually there was reduced base entry.
Mr Cox's abdomen became increasingly distended and his jejunostomy feed was stopped and TPN
was commenced. Due to an increase in sepsis he returned to theatre for a laparostomy washout, it
was discovered that his bowel loops were necrotic.
An Endoscopy following a further GI bleed confirmed an arterial bleed, and it was deemed he was
still unstable for any further surgical intervention. Mr Cox continued to deteriorate with sepsis and
MODS, consequently at this point, it was decided to withhold and withdraw treatment. Renal
replacement therapy (RRT) was withdrawn as he was still profoundly acidotic with no improvement,
and surgical intervention withheld due to instability. All other treatment was continued, but he was
'Not for resuscitation' in the event of cardiopulmonary arrest. Mr Cox died after 30 days in ITU.
Aesthetics
Aesthetical knowing is defined by Johns as the intuitive nature of grasping, interpreting, envisioning
and responding (Johns 1995). Nurses' aesthetic qualities are sometimes referred to as the 'art of
nursing'

Sepsis Case Studies
Sepsis is a phenomena that is commonly seen in the acute and critical care setting. Sepsis is defined
by the Global Sepsis Alliance ([GSA]; n.d.) as "the body's overwhelming and life–threatening
response to infection which can lead to tissue damage, organ failure, and death" (Global Sepsis
Alliance [GSA], n.d., para. 1). Severe sepsis and septic shock are major healthcare complications
that affect millions of individuals each year, worldwide. Dellinger et al. (2013) states that sepsis
causes one in four deaths and is growing in incidence (p. 583). The GSA (n.d.) states that 258,000
Americans are killed each year from sepsis–related deaths. The International Consensus Definitions
for Sepsis and Septic Shock was generated in 1991 ... Show more content on Helpwriting.net ...
(2016b) states that the Sepsis Definitions Task Force recommends the eradication of the terms sepsis
syndrome, septicemia, and severe sepsis; and in its place, combine the terminology and define sepsis
as "life–threatening organ dysfunction due to a dysregulated host response to infection" (p. 763).
There are currently no "GOLD standards of care" for sepsis management or prevention. [continue
with task force data] The Centers for Disease Control and Prevention ([CDC]; 2014) states that the
National Center for Health Statistics (NCHS) estimates that the number of individuals who were
admitted to a hospital with septicemia increased from 621,000 in 2000 to 1,141,000 in 2008.
[continue with statistical data, including mortality data]. According to the Surviving Sepsis
Campaign, careful infection control practices should be reviewed in nursing considerations, should
be established during care delivery of septic patients. Infection control measures include: hand
washing, urinary and venous catheter care, protective skin barrier, airway management, head of the
bed elevated greater than 30°, and subglottic suctioning (Dellinger, et al., 2013, p. 595). [continue
with preventative measures, i.e. handwashing

IL-6 Gene Polymorphisms
Such individual variations seem to be regulated by common nucleotide variations in the IL–6
encoding gene, located on chromosome 7p21.221 The association between IL–6 gene
polymorphisms and periodontitis in different ethnicities has been widely investigated and the results
suggest that IL–6 gene c–174G/C polymorphism is associated with periodontopathogens detection,
variations in severity of inflammation, tissue destruction, and attachment loss in periodontal
disease.222,223 It is well known that a large amount of IL–6 is secreted in response to inflammatory
stimuli such as Toll–like receptor ligands and proinflammatory cytokines including IL–1, IL–17,
and tumor necrosis factor (TNF)–α to combat infections and, finally, to promote inflammation.224
... Show more content on Helpwriting.net ...
Increased levels of IL–6 also lead to increased production of TNF–α and C–reactive protein (CRP),
which in turn, may also have an indirect impact on insulin resistance .233 Ross et al. (2010) found
that periodontal IL–6 expression increases when that disease status changes from „no disease‟ to
„one disease (periodontal disease)‟ to „two diseases (periodontitis and diabetes)‟, which may
suggest that diabetes further aggravates systemic inflammation.234 The literature suggests a two–
way relationship between periodontal diseases and diabetes, although the mechanisms in which this
relationship occurs is still not completely understood. It seems that diabetics are more susceptible to
periodontal diseases due to both a hyper inflammatory component leading to more tissue destruction
as well as an impaired immune response, which could delay/impair host's natural
healing/regenerative capabilities during the disease course. On the other hand, periodontitis may
aggravate the diabetic host inflammatory component both locally and systemically, leading to
worsening of diabetes

Sepsis Is A Poisoning Of The System By Disease Carrying...
Sepsis was known in the old days as "blood Poisoning" because it is " A poisoning of the system by
disease carrying bacteria and their toxins absorbed into the bloodstream, as from festering wounds,"
according to the World Book Encyclopedia Dictionary. 1 Because Sepsis is a severe and often fatal
disease and thought to cause 44,000 deaths a year, it is most important that it be recognized early
and treated aggressively with utmost and urgent care. If not treated early it can lead to shock and
multiple organ failure and even death. It kills more people than breast, bowel, and prostate cancer
combined; however, it can be treated successfully if detected early on. 2. Erin Dean Sepsis does not
arise on its own. It stems from another medical condition such as an infection in the lungs, urinary
tract, skin, abdomen (such as appendicitis) or other part of the body. Invasive medical procedures
like the insertion of a vascular catheter can introduce bacteria into the bloodstream and bring on the
condition. Many different types of microbes can cause sepsis, including bacteria, fungi and viruses,
but bacteria are the most common culprits. Severe cases often result from a body–wide infection that
spreads through the bloodstream, but sepsis can also stem from a localized infection. All healthcare
professionals should treat suspected sepsis with the same urgency as a heart attack, according to the
National Institute for Health and Care Excellence. (NICE) 3. Patients who are at higher

Septic Shock
Introduction
Severe sepsis and septic shock represents a significant healthcare problem among hospitalized
patients. It is a major cause of mortality especially among older patients and patients with multiple
pathologies, many of whom are admitted through emergency departments (EDs) (Coen et al., 2014).
The research suggests that while not all patients with septic shock is admitted through the ED, the
care received by patients in the ED may significantly impact their prognosis (Coen e.t al., 2014).
EGDT has been incorporated into EDs to treat patients with severe sepsis or septic shock in the form
of Surviving Sepsis Campaign (SSC). EGDT involves following a well–defined algorithm during
the first 6 hours of treatment that includes administering ... Show more content on Helpwriting.net ...
A total of 60 patients, mean age of 66.3 years and 86.7% male admitted to the ED and who received
resuscitation using the standard EGDT algorithm for severe sepsis and septic shock and who were
treated with CRRT because of septic AKI. The study conducted from June 2008 to February 2013 at
a tertiary hospital in Seoul, Korea. The participants were assigned to two groups; on the basis of the
median between the time they started the EGDT and the CRRT. The main outcomes measure the
cause of 28–day mortality. The 28–day mortality rate was 43.3%. The overall cause of mortality rate
was significantly higher for the late CRRT groups, than the early CRRT group 56.7 versus. 30.0%.
The authors conclude that initiating CRRT early may be beneficial to improving mortality rate
among patients with severe sepsis or septic shock, but indicate that more clinical trials are needed to
accurately determine whether early CCRT is more efficacious than late CRRT in the treatment of
septic

Systematic Review Paper
Systematic Review Grid/ Research Evaluation Tool (1)
Topic: Sepsis
Study: The use of serum procalcitonin versus C–reactive protein as a diagnostic marker of sepsis in
the critically ill patient
Author
Title
Journal
Year, Volume Issue Pages Nargis,W., Ibrahim, M., Ahamed, B.U. (2014). Procalcitonin versus C–
reactive protein: Usefulness as biomarker of sepsis in
ICU patient. International Journal of Critical Illness & Injury Science, 4(3): 195–199.
Background
Study rational
Objective Early diagnosis of sepsis continues to be a challenge in the ICUs. Procalcitonin (PCT) has
proven to be a reliable laboratory marker for sepsis. Study sought to evaluate the use of PCT
compared to CRP as a routine biochemical marker. ... Show more content on Helpwriting.net ...
(2013). Changes in circulating procalcitonin versus C–reactive protein in predicting evolution of
infectious disease in febrile, critically ill patients. PLoS ONE, 8(6): e65564. doi:
https://doi.org/10.1371/journal.pone.0065564.
Leli, C., Cardaccia, A., Ferranti, M., Cesarini, A., D'alo, F., Ferri, C., Cenci, E., & Mencacci, A.
(2014). Procalcitonin better than C– reactive protein, erythrocyte sedimentation rate, and white
blood cell count in predicting DNAemia in patients with sepsis. Scandinavian Journal of Infectious
Disease, 46: 745–752. doi: 10.3109/00365548.2014.936493.
Li, H., Liu, Z., Zhao, S., Zhang, D., Wang, S., & Wang, Y. (2013). Measuring both procalcitonin and
C–reactive protein for a diagnosis of sepsis in critically ill patients. Journal of International Medical
Research, 42(4): 1050–1059. doi: 10.1177/0300060514528483.
Lin, C., Lu, J., Chen, Y., Kok, V., & Horng, J. (2017). Diagnostic value of serum procalcitonin,
lactate, and high–sensitivity C–reactive protein for predicting bacteremia in adult patients in the
emergency department. PeerJ, 5:

Causes And Consequences Of Sepsis
Sepsis, also referred to as blood poisoning is a potentially life threatening complication that results
from an infection. These infections, typically caused by bacteria cause chemicals to be released in to
the bloodstream in order to fight the infection. As a result, this triggers an inflammatory response
throughout the body, which in turn may cause a cascade of changes, which may damage organ
systems, causing them to fail. The infection present in the blood in this case becomes systemic,
spreading through the body (Abraham, Matthay & Dinarello, et al, 2000). Sepsis may start with any
given type of infection from small or minor infections such as a urinary tract infection and abscessed
tooth to more serious ones such as meningitis. Septic shock on the other hand is the most severe
form of sepsis, and has been associated with high mortality rates. Uncontrolled sepsis results in
septic shock, which is largely the result of progressive compromise of various organ systems and the
eventual development of multiple organ failure. When sepsis progresses to septic shock, there is a
drastic drop of blood pressure, which may cause death. With regards to septic shock, the onset of
treatment determines chances of outcome. Whereas early intervention may reduce mortality rates,
late septic shock reduces the chances of survival.
2. Etiology
One of the most common causes of sepsis is bacterial infection. However, it may also arise from
other conditions that may

Sepsis Syndrome Definition
Sepsis
The European Society of Intensive Care Medicine (ESICM) and its American counterpart (SCCM)
recently unveiled an updated definition of sepsis syndrome in adults (Sepsis–3) [1]. Previous
diagnostic criteria have been revalued and retrospectively validated in several large patient
databases. The consensus document, published in the journal JAMA, have been produced by a
working group of 19 experts in critical care, infectious diseases, surgery and respiratory medicine.
Aged criteria with obvious flaws
The first North American, consensus–based sepsis definition was published in 1992 [2]. The aim
was to bring the structure to an overgrown subject field. The concepts of "severe sepsis" and "septic
shock« established. The definition began with a systemic inflammatory response syndrome (SIRS),
where the more advanced stages involved organ dysfunction / hypoperfusion / fluid refractory
hypotension and ... Show more content on Helpwriting.net ...
Probably , this can be largely explained by the absence of a rigorous definition. A patient due to mild
virosis have low–grade fever and a slightly elevated heart rate but otherwise unaffected general
condition, can be categorized as septic ( overdiagnosis ) . When the immunkompetentes
inflammatory response may be considered physiologically adaptive and appropriate , the definition
in this respect limited validity . Likewise, the condition of a critically ill infected patient with
multiple organ failure and significant mortality risk escape classification as sepsis due to the absence
of several SIRS criteria ( for diagnosis ) [ 4, 5 ] .
When dealing with patients, especially in intensive care , it is often difficult to determine the
infection 's role in the onset of SIRS , which is common and likely often multifactorial (as a result of
trauma, surgery, burns , ischemia / reperfusion , pancreatitis and / or infection ) [6 , 7].
New definition and the new

Shock Prep
David A Daves
SIM PREP........
02/22/13
Preparation Questions
Differentiate the following terms:
Systemic Inflammatory Response Syndrome (SIRS):
Is aggressive widespread inflammatory response to infection (sepsis) or perceived invader. Also,
ischemia, infarction and injury.
Sepsis:
Is a systemic inflammatory response in the presence of a documented infection.
Severe sepsis:
Is sepsis complicated by organ dysfunction, is diagnosed in more than 750,000 patients per year and
has mortality rates as high as 28%–50%.
Septic shock:
Is the presence of sepsis with hypotension despite fluid resuscitation along with the presence of
inadequate tissue perfusion.
Multiple organ dysfunction syndrome (MODS):
Is the failure of two or ... Show more content on Helpwriting.net ...
This causes the ventricles to dilate in order to maintain adequate stroke volume. Usually, this will
improve over the next 7–10 days.
Discuss the cascade of host inflammatory responses that produce the major detrimental effects seen
in sepsis due to gram–negative bacteria.
Inflammatory variables:
Leukocytosis (WBC > 12 x 10(3) cells
Leukopenia (WBC count <4.0 x 10(3) cells
Normal WBC count with > 10% immature forms
Elevated C–reactive protein
Elevated procalcitonin

What is early–goal–directed therapy in the management of sepsis? 1. Evidence of adequate tissue
perfusion 2. Restoration of normal or baseline BP 3. Return/recovery of organ function 4. Avoidance
of complications from prolonged states of hypoperfusion
Identify the treatment guidelines currently recommended for the management of sepsis and septic
shock.
Discuss how the drug dobutamine affects cardiac output. Identify the nursing implications with the
administration of this drug.
Discuss how norepinephrine works and its indications for use. Identify the nursing implications with
the administration of this drug.
Discuss how drotrecogin alfa works and its indications for use. Identify the nursing implications
with the administration of this drug.
Describe the concept of ScvO 2 monitoring. Identify the significance of abnormally high and low
ScvO2 readings.
Describe the nursing responsibilities in

Sepsis: Inflammation and White Cell Count Essay
This is the case study of Mr. Jones, a 65 year old male, who was admitted to the emergency
department with persistent cough and episodes of chest pain over the last five days. He appeared to
be experiencing worsening dyspnoea, fever and feeling unwell. It was also noted that he had a poor
urine output over the last 24 hours. An indwelling catheter was inserted which only obtained 20 mLs
of amber urine. Mr. Jones clinical assessment revealed that his Glasgow Coma Score was 11/15. He
was opening his eyes to speech, only making inappropriate words and localizes to pain. He was also
pyrexial with a temperature of 39.0 ˚C, diaphoretic with hot peripheries, hypotensive BP 90/45
mmHg (MAP 60 mmHg), and tachyopneic at 30breaths/min and ... Show more content on
Helpwriting.net ...
Mr. Jones white cell count is elevated and revealed at 1400 mm while his CRP is also raised.
Cytokinines are the one of the primary mediators that signal other cells to release additional
mediators such as tumour necrosis factor–a (TNF–a) interleukin (IL)–1, IL–6, IL–8, interferon,
leukotrienes, histamine, bradykinin, prostaglandins, thromboxane A2, serotonin, nitric oxide,
arachidonic acid, platelet–activating factor (PAF), oxygen free radicals and myocardial depressant
factor (Munford, 2001:67). If the invading organism is a gram negative bacterium, endotoxins are
also released, which further stimulate the production of these inflammatory mediators (Jones &
Bucher, 1999:134). Tumour necrosis factor (TNF) is responsible for the disruption of the tight
junction between endothelial cells which results in an increased permeability to plasma proteins and
fluid, which worsens fluid accumulation in the alveoli further impairing gas exchanged (Bersten &
Soni, 2009:709). TNF comprises of two different molecules, firstly TNFa which leads to
programmed cell death in target cells, and when combined with IL–1 which acts on the central
nervous system causing lethargy (Marieb, 2004). TNFB stimulates granulocyte activity and B cell
proliferation which shows an increase in neutrophil count (Jean– Baptise, 2007:63). Monocytes,
macrophages, lymphocytes, astrocytes and endothelial cells secrete IL–1 which promotes fever,
anorexia,

Symptoms And Treatment Of A Tooth
TERMINOLOGY
CLINICAL CLARIFICATION o Localized collection of purulent material associated with a tooth
due to bacterial invasion of the pulp space1,2 CLASSIFICATION1 o Gingival abscess
 Involves marginal gingiva or interdental papilla o Periapical abscess
 Present at the apex of the root of a tooth o Periodontal abscess
 Localized within the tissues adjacent to the periodontal pocket o Pericoronal abscess
 Localized within the tissue surrounding the crown of a partially or fully erupted tooth o
Combined periodontic–endodontic abscess
 Localized, circumscribed areas of infection that originate from the periodontal and/or pulpal
tissues
 Infection invades both the periodontal tissue the pupal tissue DIAGNOSIS CLINICAL
PRESENTATION ... Show more content on Helpwriting.net ...
poorly controlled diabetes mellitus, AIDS) or taking immunosuppressive medications (e.g.
chemotherapy, may have an increased risk for systemic infections caused by dental abscess6
DIAGNOSTIC PROCEDURES Primary diagnostic tools2
 Superficial abscesses often detectable by physical examination and palpation
 Periapical x–ray or orhtopantogram recommended if the abscess is not visible or palpable on
physical examination

Neutrophils Research Paper
Redness, swelling, pain, heat, and loss of function are all cardinal signs of inflammation. Acute
inflammation lasts from a few minutes to several days, and is characterized by the exudation of fluid
and plasma components and emigration of leukocytes, predominantly neutrophils, into the
extravascular tissue. The physiologic mechanisms causing the wound changes are a result of the
acute inflammatory response and the immediate vascular changes that occur, including vasodilation
and increased capillary permeability; the influx of inflammatory cells such as neutrophils the effects
of inflammatory mediators, which produce fever and other systemic signs and symptoms as seen in
Carlton. Endothelial cells, platelets and neutrophils and Monocytes are ... Show more content on
Helpwriting.net ...
In an acute reaction, leukocytosis occurs as a result of increasing the number of circulating white
blood cells to aid the immunity response. The movement of white blood cells to the site of injury
occurs as a result of chemotaxis. Margination and emigration are the events that describe the action
of circulating leukocytes from the blood to the injured tissue. To summarize, leukocyte margination
is mediated by vasodilation and slowing of blood flow. Rolling results from initial interaction of
leukocyte and endothelial adhesion molecules. There is an increase in expression of these molecules
on cells as the cells are activated by inflammatory cytokines. Firm adhesion occurs following more
adhesion molecule interaction and this interaction leads to emigration through the vessel wall (Akira
& Kawai, 2012). Neutrophils arrive early to phagocytose microbes and cellular debris (Sadik, Kim
& Luster, 2011). Monocytes travel in the blood and migrate to the injured tissue where they become
macrophages. These cells are capable of engulfing greater quantities of foreign material and can
move to the lymphatic system, where they prime specific immunity (Shi & Pamer,

Sepsis Early Detection and Treatment
Running Head: SEPSIS DETECTION AND TREATMENT
Sepsis Early Detection and Treatment
Steven H. Gregory
Chamberlain College of Nursing
March28, 2009
Sepsis Early Detection and Treatment Severe Sepsis affects 750,000 Americans and causes more
than 200,000 deaths annually. Sepsis is a complex condition that results from an infectious process
that represents the body's response to infection and involves systemic inflammatory and cellular
events that result in altered circulation and coagulation, endothelial dysfunction and impaired tissue
perfusion (Kleinpell, 2005). Associated mortality rates with sepsis in the United States have
remained largely unchanged for several decades. Through an international collaboration known as
the ... Show more content on Helpwriting.net ...
Treatment of Sepsis
As stated in Rivers, Nguyed, Havstad, Ressler, Muzzin, Knolich & et al. (2001):
Early hemodynamic assessment on the basis of physical findings, vital signs, central venous
pressure, and urinary output fails to detect persistent global tissue hypoxia. A more definitive
resuscitation strategy involves goal–oriented manipulation of cardiac preload, afterload, and
contractility to achieve a balance between systemic oxygen delivery and oxygen demand. End points
used to confirm the achievement of such a balance (hereafter called resuscitation end points) include
normalized values for mixed venous oxygen saturation, arterial lactate concentration, base deficit,
and pH. Mixed venous oxygen saturation has been shown to be a surrogate for the cardiac index as a
target for hemodynamic therapy. In cases in which the insertion of a pulmonary–artery catheter is
impractical, venous oxygen saturation can be measured in the central circulation (p. 1368).
The focus for the general care nurse outside of the ICU is to be able to recognize sepsis and to
initiate appropriate interventions in an appropriate amount of time. Nurses need to facilitate the
transfer of the patient to an ICU as urgently as possible. Once sepsis is suspected, it is important to
closely monitor patients for signs and symptoms of progression with increasing frequency of
assessments. While awaiting transfer of a patient to the ICU

Case Study: Immediate Sepsis Intervention In The Emergency...
Capstone Part I: Immediate Sepsis Intervention in the Emergency Department
NUR 4169C Applications in Evidence Based Practice for BSNs
Professor Dr. Susan Poole, DNP, CNE
by
Jenny Cruz
August 2018
Capstone Part I: Literature Review
Introduction to Problem Sepsis is a condition of growing concern for nursing professionals, as the
mortality rate has increased each year since its initial documentation in the early 1990s (Levy et al.,
2012). Sepsis was first defined in 1991 as a systemic inflammatory response syndrome (SIRS).
Since this time, improvements have been made in developing a worldwide definition of sepsis (Levy
et al., 2012). Specifically, sepsis is considered to be a life–threatening dysfunction of the organs that
results from the dysregulation of a host response to an infectious agent (American Association of
Critical–Care Nurses, AACN, 2018). ... Show more content on Helpwriting.net ...
129)." Defining sepsis has been a struggle for researchers and practitioners, since there is no gold
standard for testing this condition globally (Singer, 2016). Additionally, third world countries face
difficulties in performing expensive testing in order to achieve clear and definitive result. According
to the AACN (2018), sepsis is the third leading cause of death in the U.S as well as costs about 20
billion dollars yearly to the acute hospital care

Pre Eclampsia Research Paper
A popular hypothesis explaining the cause of pre–eclampsia is immune maladaptation(14).To date,
the etiology of preeclampsia is not completely understood, however an increasing body of evidence
indicates the involvement of the immune system in the form of faulty tolerance to the conceptus as
an fundamental part of the pathogenesis(50).The immune system has been incriminated in the
pathophysiology of preeclampsia with alterations in the cellular immunity and cytokines production
that are work toward the maintenance of pregnancy(76). The maternal immune response against the
fetus and placenta has too been proposed to have an central role in the pathogenesis of
preeclampsia(185).
In contrast to normal pregnancy, there are indications of increased inflammatory responses and also
of an immune deviation toward Th1 in the established preeclamptic pregnancy (183). Accompanied
by a shift in the direction of Th1–type immunity as identified by the increased IL–2/IL–4 ratio and
IFN– γ /IL–4 ratio , there is too increased circulating levels of the pro–inflammatory cytokines IL–6
and TNF–α, also the chemokines IL–8 , interferon–inducible protein–10 (IP–10) and monocyte
chemoattractant protein 1 (MCP–1), as well as the adhesion molecules intercellular adhesion
molecule 1(ICAM–1) and vascular cell adhesion molecule 1 (VCAM–1), in preeclampsia as
compared ... Show more content on Helpwriting.net ...
NK cells are usually disappeared by full term. Conversely, in preeclampsia, NK cells continue to be
active in the maternal decidua. Activation of NK cells might be accountable for the Th1–
predominant inflammatory response profile experiential in preeclampsia, with increased IFN– γ and
TNF–α level. The NK cell–derived Th1 cytokines may thus have a role in the pathogenesis of
preeclampsia, maybe by inhibiting trophoblast invasion locally, and/or by the induction of
endothelial damage and systemic inflammation

Examples Of Microbiologic Automation
1. The inflammation process begins by a response to any agent that causes cell injury or bacteria
response. This could either be physical, chemical or microbiologic. Physical response is can either
by to heat or cold. Concentrated acid or alkali are some examples of chemical response. Some
examples of microbiologic response is bacterium or virus. After the inflammation response begins,
the capillaries begin to dilate. The blood vessels begin to expand, which increases the blood flow.
This causes the skin to increase in temperature and redness. Because of the dilation, the capillary
permeability, a condition of the capillary wall structure that allows blood elements and waste
products to pass through the capillary wall to tissue spaces, increases. The leakage of plasma causes
the skin or affected area to begin to swell. White blood cells, leukocytes, begin to migrate to the site
of injury. Polymorphonuclear is the most important cell. At this point in the inflammation process,
the systemic response begins. This is a set of physiologic actions that fight the infection and heal
wounds. Exudates are fluids and cells that filled the tissue space during inflammation. There are
many different types of exudate: serous, purulent, fibrinous, hemorrhagic based, and purulent
exudate. The last part of the inflammation process is the outcome. This depends on how ... Show
more content on Helpwriting.net ...
The patient shows signs and symptoms of systemic reaction. The patient started with an acute injury,
but the burn quickly became infected. The systemic inflammatory response syndrome (SIRS) was
caused by the burn wound becoming infected. In order to properly diagnosis this reaction, the health
care provider needs a little more information. Blood work should be drawn from Mrs. X (Systemic
Inflammatory Response Syndrome, 2015). Her body is trying to fight off the infection that has
developed in the burn. The redness is caused by the release of local vasodilation substances
(Systemic Inflammatory Response Syndrome,

Risk Factors Leading For Blood Myeloid Dendritic Cells
risk factors such as tobacco smoking, male gender, race/ethnicity, stress, and aging. As an example,
Carrion et al. (2012), proposed a role for blood myeloid dendritic cells in sheltering and circulating
pathogens from the subgingival microbial biofilm in the periodontal pocket which are then
transported to atheromatous plaques lining coronary and other arteries. This and other pathways may
play a role in providing key signals for myeloid dendritic cell differentiation and atherogenic
changes (39). However, in recent years, the host response, rather than periodontopathogens, seems
to be the primary focus for elucidating the link between periodontal disease and CVD. Of particular
interest, when pro–inflammatory mediators such as TNF–α, ... Show more content on
Helpwriting.net ...
This hypothesis links inflammatory periodontal disease to CVD, such as atherosclerosis, without
necessarily invoking bacteria or their products interacting with the cardiovascular system (38). In
this regard Craig et al. (2003) found that the patients with severe rapidly progressing periodontitis
showed a 100% higher hs–CRP level in the circulation (plus other biomarkers) than patients with
mild periodontitis (37). Regarding mechanisms, CRP can form a complex with oxidized low–
density lipoprotein (LDL) cholesterol which, when phagocytosed by macrophages infiltrating
atheroscleromatous plaques, can differentiate into foam cells (52). The production of MMPs, for
instance MMP–8 (collagenase–2) and MMP–9 (gelatinase B), by these modified inflammatory cells,
can destroy the thin collagen ''cap'' that covers cholesterol– rich plaques lining the coronary arteries
leading to "plaque rupture, thrombosis, and acute myocardial infarction" (53–55).
3.2. Diabetes
Many studies in the literature have linked periodontitis and both type I and type II diabetes
(17,30,56,57). Diabetes mellitus is characterized by hyperglycemia which historically has been the
main diagnostic feature of the disease. Long–term hyperglycemia produces a range of

Essay On Cardiopulmonary Bypass
Cardiopulmonary bypass (CPB) has contributed to the evolution of modern day cardiac surgery. The
establishment of extracorporeal circulation has helped the surgical team to carry out complicated
surgical manouevers for treatment of complex cardiac lesions, especially complex congenital
cardiac lesions, some of which were hitherto considered as inoperable. The advances in equipment
and use of innovative techniques in perfusion have contributed to decreased mortality and/or
morbidity in patients undergoing cardiac surgery in the modern day settings. However the necessity
for monitoring the patient on cardiopulmonary bypass is of paramount importance. One of the key
areas monitored during CPB is the neurological status of the patient. The inherent features of CPB
like unphysiological flows, the fluctuations of temperature (use of hypothermia and rewarming),
practices like hemodilution, organ protection strategies and unavoidable consequences like Systemic
Inflammatory Response Syndrome (SIRS), all contribute to neurological sequelae. The possibility of
neurological sequelae is enhanced in neonatal cardiopulmonary bypass, wherein the concept of
extra–corporeal circulation is stretched to its limits. Hence neurological monitoring assumes a
central place in the practice of 'safe, optimal perfusion' . ... Show more content on Helpwriting.net ...
It receives almost 14% of the total cardiac output. The average cerebral blood flow is
55ml/min/100gm of brain tissue, which can increase upto 100ml/min/100gm brain tissue in
neonates. The brain also contributes to 25% of the Total Oxygen Consumption
(3.5mlO2/min/100gm brain tissue). Studies have revealed that the white matter of the brain
contributes to almost 94% of the cerebral oxygen consumption whereas the gray matter contributes
the remaining 6%. The sensorimotor area of frontal cerebral cortex is most susceptible to ischemic
brain injury

Types Of Multiple Organ Dysfunction Syndrome
Introduction
Multiple Organ Dysfunction Syndrome, also known as MODS, can occur after any severe injury or
disease process that activates a large systemic inflammatory response which includes any kind of
shock (Sole, 2013, 283). Like with any kind of dysfunction, organ dysfunction can lead to further
organ failure and ultimately death (Sole, 2013, 283). The most common causes of MODS includes
severe sepsis and septic shock, which represents the highest cause of mortality in these conditions
(Semeraro, 2011, 293). The body's immune system along with the body's response to stress can be a
precipitating factor to maldistribution of circulating volume, global tissue hypoxia, and metabolic
alterations which results in damage to the organs (Sole, 2013, 283). According to Ignatavicius
(2013), once the damage has begun, a vicious cycle follow resulting in further cellular and organ
damage. The first organs to lose their function include the liver, heart, brain, and kidneys, with the
most devastating change being the damage to the heart muscle (Ignatavicius, 2013, 814). Multitudes
of research has been done to further explain the cause and possible treatments for this deadly
syndrome.
Pathophysiology
MODS can classified as either primary or secondary. According to Sole (2013), Primary MODS is a
result of an injury to a specific organ which can occur in shock, trauma, burns, or infection that
causes an impairment in the perfusion of blood that can either be localized or systemic,

Sepsis Case Study

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